A novel predictive marker for the recurrence of nasal polyposis following endoscopic sinus surgery.

We aimed to determine the value of neutrophil-to-lymphocyte (NLR) ratio for prediction of recurrence in patients subjected to endoscopic sinus surgery. Higher neutrophil counts mean more chronic inflammation so the NLR value could show the inflammatory level resulting with higher incidence of recurrence. From January 2011 to March 2013, we performed a retrospective review of the complete blood count samples from 192 patients with chronic sinusitis who underwent endoscopic sinus surgery. The patients were divided into two groups based on the presence of nasal polyps. NLR and platelet-to-lymphocyte (PLR) ratios were analyzed. Receiver operating characteristic (ROC) curve analysis was performed to determine the cut-off value for significant differences in variables between the recurrence and non-recurrence groups. The ROC analysis results revealed an NLR cut-off of 3.13 and a PLR cut-off of 208.75. Our analysis revealed that NLR is an independent risk factor for recurrence of chronic sinusitis in patients subjected to endoscopic sinus surgery (p = 0.006), whereas the PLR was not a predictive factor for recurrence (p = 0.167). Our study revealed that the NLR could be used to predict disease recurrence before endoscopic sinus surgery. However, additional studies are needed to confirm these results.

A novel predictive marker for the viscosity of otitis media with effusion.

OBJECTIVES: To evaluate the significance of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio for the prediction of the viscosity of otitis media with effusion. METHODS: This retrospective study was performed on 81 patients who were admitted to the otolaryngology clinic.The patients were divided into two groups according to their effusion type, as serous or mucoid, which was defined intraoperatively after myringotomy. The NLR and PLR were calculated as a simple ratio between the absolute neutrophil/platelet and absolute lymphocyte counts.Tympanostomy tube insertion was performed for all cases.Under direct visualization, the effusion was aspirated and classified as serous or mucous. RESULTS: We postulated that an NLR value of less than 1.38 may show mucoid effusion and if the PLR value is less than 97.96, the effusion is mucoid. CONCLUSIONS: We speculate that a useful predictor of viscosity for a middle ear effusion could prevent unnecessary surgeries and additional costs in the treatment of EMO. Additional studies are needed to confirm our results.

Choanal polyp originating from the inferior turbinate presenting as nasal polyposis.

Although choanal polyps frequently arise from the maxillary sinus, a choanal polyp originating from the inferior turbinate is a rare entity. A 14-year-old girl who had a history of bilateral nasal obstruction with snoring, mouth breathing and nasal discharge for 10 years was presented. On endoscopic examination, a polypoid mass completely obliterated the right nasal cavity. The left choana was also totally occluded by the polypoid mass. Endoscopic polypectomy was performed and it was observed that the polyp originated from the right inferior turbinate. Choanal polyps arising from the inferior turbinate should be kept in mind in the differential diagnosis of unilateral nasal polypoid masses.

Clinical impact of ectopic teeth in the maxillary sinus.

OBJECTIVE: To evaluate the clinical features, aetiologic factors, challenging properties (such as radio opacity in Water's view in a patient with no sinusitis), signs and symptoms of the ectopic teeth in the maxillary sinus. STUDY DESIGN: Clinical symptoms and radiographic findings of 14 patients with ectopic teeth in the maxillary sinus were evaluated. Computed tomography (CT) and conventional radiographic images of maxillary sinus and clinical findings were compared with each other with regard to the final diagnosis. RESULTS: Water's view is inadequate to diagnose ectopic tooth in the maxillary sinus in some cases. Panoramic radiographs may be preferred before CT to evaluate the ectopic tooth in the maxillary sinus as structure of a tooth can be clearly detected on panoramic radiographs. Crowding was the most common aetiologic factor among the 14 cases. CONCLUSION AND SIGNIFICANCE: The patients with ectopic tooth in the maxillary sinus should be evaluated thoroughly by complete otorhinolaryngologic, intraoral examinations and proper diagnostic imaging procedures in order to avoid misdiagnosis of maxillary sinusitis. As the opacity of the maxillary sinus in Water's view due to ectopic tooth can be misinterpreted as maxillary sinusitis, patients who have sinusitis-like complaints and opacity of maxillary sinus in Water's view who are resistant to medical treatment should be evaluated with respect to the presence of ectopic tooth.

Incidence of unexpected pathology in routine adenoidectomy specimens.

OBJECTIVE: The aim of this study was to determine the incidence of unexpected pathologies in adenoidectomy specimens and necessity for histopathologic evaluation of adenoid tissue. MATERIALS AND METHODS: All patients younger than 16 years who underwent routine adenoidectomy were reviewed. Patients were excluded if the primary surgery was other than routine adenoidectomy such as nasopharyngeal biopsy for suspicion of malignancy or other pathology. RESULTS: One thousand one hundred eighty-four patients (683 males, 501 females) were involved in this study. The mean age was 7.53+/-3.24 years, ranging between 2 and 16 years. There was no patient with unexpected pathology among 1184 routine and primary adenoidectomy procedures. However, one patient had unexpected pathology among 33 revision adenoidectomy procedures (3%). CONCLUSIONS: There was no occult pathology in routine primary adenoidectomy. The incidence of unexpected pathology in revision adenoidectomy was 3%. Microscopic evaluation of adenoid tissue gives some knowledge about histological properties and rarely some unexpected pathologies. Searching for malignancy is unnecessary in routine primary adenoidectomy cases without any other clinical, radiological and laboratory findings.

Squamous cell metaplasia of the nasopharyngeal epithelium and its association with adult-onset otitis media with effusion.

CONCLUSION: The common association between adult-onset otitis media with effusion (AO-OME) and squamous cell metaplasia (SCM) of the epithelium of Rosenmüller's fossa, which is near the Eustachian tube orifice, implies the predictive role of metaplasia, which probably compromises the drainage function of the middle ear. OBJECTIVE: To determine the effects of nasopharyngeal epithelial changes (SCM) on AO-OME. AO-OME is a multifactorial and insidious disease that may necessitate detailed investigation, i.e. biopsy of the nasopharynx, because of possible underlying nasopharyngeal malignancy. MATERIAL AND METHODS: Fifty-two patients with AO-OME (study group) and 29 with a unilateral neck mass in the posterior triangle without AO-OME (control group) were enrolled. Nasopharyngeal biopsies taken from all subjects were evaluated with regard to surface epithelial changes of the nasopharynx. RESULTS: Nasopharyngeal biopsies revealed SCM in 34/52 patients (65%) in the study group and 9/29 (31%) in the control group (p<0.05). During the follow-up period, recurrence of effusion occurred in 56% of the group with SCM and 22% of the group without it.

What is the relationship between chronic sinus disease and isolated nasal septal deviation?

OBJECTIVE: The aim of this retrospective study is to examine the role of isolated nasal septal deviation (NSD) in the pathogenesis of chronic rhinosinusitis (CRS). STUDY DESIGN AND SETTING: The interaction between isolated NSD and chronic sinus disease were retrospectively evaluated in 1452 patients. Out of 1452 patients, 152 patients were included in the study. Patients with anatomical variants other than NSD were excluded from the study. Patients with NSD were enrolled in the study group and patients without NSD were enrolled in the control group. RESULTS: There was no statistically significant difference between NSD group and non-NSD group with respect to the CRS. CONCLUSIONS: The mild to moderate degree of NSD was not a risk factor for chronic sinus disease. Only gross deviation of the nasal septum itself is a risk factor for the development of CRS. SIGNIFICANCE: Excluding the subjects with ostiomeatal anatomic variations has differentiated this study from the previously reported researches (isolated NSD).

The effect of topical corticosteroid on basic fibroblast growth factor in nasal polyp tissue.

BACKGROUND: The etiology of nasal polyposis and pathophysiological mechanisms of polyp formation is still poorly understood. Experimental models have suggested that nasal polyp growth requires extracellular matrix formation and is associated with fibroblast proliferation. Intranasal corticosteroids appear to be useful in reducing nasal polypoid lesions and the likelihood of polyp recurrence after surgery. Basic fibroblast growth factor (bFGF) is a potent angiogenesis factor and is mitogenic for a wide range of cell types. We investigated the alteration of bFGF levels in nasal polyp tissue after administration of topical corticosteroid. METHODS: Nasal polyp tissues were obtained from 36 patients with diffuse nasal polyposis before and after topical nasal steroid treatment. As a topical nasal steroid mometasone furoate was given for 4 weeks in a dosage of 200 microg/day. The bFGF levels were measured by competitive enzyme immunoassay method. RESULTS: The mean levels of tissue bFGF, before and after topical nasal steroid treatment, were 1485 +/- 826 ng/mg protein (range, 416-3434 ng/mg) and 1340 +/- 749 ng/mg protein (range, 330-3288 ng/mg), respectively. The levels of bFGF in nasal polyps were significantly lower than those before treatment after administration of topical nasal steroid (p = 0.011). CONCLUSION: Administration of topical nasal steroid decreases bFGF levels of nasal polyp. It may be suggested that one of the effects in diminishing the size of nasal polyps is by decreasing the bFGF.

Nitric oxide level in the nasal and sinus mucosa after exposure to electromagnetic field.

OBJECTIVE: The purpose of this study was to examine the changes in nitric oxide (NO) level in the nasal and paranasal sinus mucosa after exposure radiofrequency electromagnetic fields (EMF). STUDY DESIGN AND SETTING: Thirty male Sprague-Dawley rats were randomly grouped as follows: EMF group (group I; n, 10), EMF group in which melatonin received (group II; n, 10) and the control (sham operated) group (group III; n, 10). Groups I and II were exposed to a 900 MHz. Oral melatonin was given in group II. Control rats (group III) were also placed in the tube as the exposure groups, but without exposure to EMF. At the end of 2 weeks, the rats were sacrificed, and the nasal and paranasal sinus mucosa dissected. NO was measured in nasal and paranasal mucosa. RESULTS: The nasal and paranasal sinus mucosa NO levels of group I were significantly higher than those of the control group (group III) ( P < 0.05). However, there was no statistically significant difference between group II and the control group (group III) regarding NO output ( P > 0.05). CONCLUSION: Exposure to EMF released by mobile phones (900 MHz) increase NO levels in the sinus and nasal mucosa. SIGNIFICANCE: Increased NO levels may act as a defense mechanism and presumably related to tissue damage. In addition, melatonin may have beneficial effect to prevent these changes in the mucosa.

Intercellular adhesion molecule-1 expression in nasal polyps treated with corticosteroid.

PURPOSE: The aim of this study was to compare intracellular adhesion molecule-1 (ICAM-1) expression in nasal polyp cases who were administered topical corticosteroid and in middle turbinates. MATERIALS AND METHODS: Twenty-four patients with nasal polyps were included in the study group. These patients were treated with 100 microg budesonide in each nostril twice daily for 2 months before the surgery. Twenty-one nonatopic patients with concha bullosa were included in the control group. The specimens were taken from patients undergoing endoscopic surgery. RESULTS: In polyps, significantly higher mean ICAM-1 intensity scores were found by comparison with the control turbinates. CONCLUSIONS: Corticosteroid treatment in patients with nasal polyps does not diminish ICAM-1 to that of turbinate tissue. The initiating events in the formation of nasal polyps still occur in these patients despite treatment with the topical nasal steroid.

Allergic contact dermatitis prevalence in patients with eczematous external otitis.

Eczematous external otitis, because of its basic allergic nature, tends to be chronic or recurrent. The purpose of our study was to investigate the association between allergic contact dermatitis and chronic eczematous external otitis. Sixty-six patients with eczematous external otitis and 48 healthy volunteers were included in this study. All the patients were tested with an epicutaneous patch test. In the study group, the average recurrent attack rate was 6.1+/-1.5 (between 4-9 times during the last year) in the patch test positive eczematous external otitis patients, and 4.9+/-1.3 (between 4-8 times during the last year) in the patch test negative patients (p = 0.002). The epicutaneous patch test was positive in 19 (28.8%) out of 66 cases with chronic eczematous external otitis, and in 3 (6.3%) out of 48 cases in the control group. The difference between the two groups was statistically significant (p = 0.003). The most common reactions were due to neomycin sulfate and potassium dichromate in this study. These results suggest that, in some cases eczematous external otitis may be considered as a form of delayed type hypersensitivity to allergen stimuli. Patients suffering from eczematous external otitis symptoms should be investigated for allergens.

The role of free oxygen radicals on the development of otitis media with effusion.

OBJECTIVE: The purpose of this study was to determine if free oxygen radicals (FORs) and antioxidant enzyme activities have some role in pathogenesis of otitis media with effusion (OME) in children with adenoid hyperplasia. METHODS: Seventy-four patients were enrolled in three groups of this study. The study group (Group I) included 26 patients who had adenoidectomy with ventilation tube placement due to chronic OME. The control adenoid group (Group II) consisted of 28 age-matched patients who had adenoidectomy without ventilation tube insertion. Twenty children were included in the healthy control group (Group III). Erythrocyte malondialdehyde (MDA) levels, superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GSH-Px) enzyme activities were investigated in the venous blood sample. RESULTS: Erythrocyte MDA level and GSH-Px enzyme activity in the blood samples of study group (Group I) were significantly higher than those of Group II and Group III (P < 0.05). SOD enzyme activity in the blood samples of Group I was significantly lower than Group II (P < 0.05), and were significantly higher than Group III (P < 0.05). CAT enzyme activity of Group I was significantly lower than that of Group III (P < 0.05). However, there was no statistically significant difference between Group I and Group II regarding CAT antioxidant enzyme activity (P < 0.05). CONCLUSIONS: The inflammation of the middle ear increases the level of FORs in erythrocyte. FOR level is normally maintained at a steady state by antioxidant enzymes. When the antioxidant defense system is weakened, the increased FORs may contribute to OME formation. We supposed that, antioxidant vitamins C and E, and scavenger enzymes such as CAT, SOD and GSH-Px may be added in the management of OME.

Asymptomatic food hypersensitivity prevalence in patients with eczematous external otitis.

PURPOSE: The purpose of our study was to investigate the association between food hypersensitivity and eczematous external otitis. MATERIALS AND METHODS: In this cross-sectional study, 27 patients with eczematous external otitis and 16 healthy volunteer were included. The existence of food hypersensitivity was defined by positive epicutaneous prick test and specific immunoglobulin E (IgE) antibodies. RESULTS: Food allergy test was positive in 13 (48.1%) out of 27 cases with eczematous external otitis, and it was positive in 2 (12.5%) out of 16 cases in control group. The difference between 2 groups was statistically significant (P =.02). Specific IgE seropositivity (51.9%) was high in the patients with eczematous external otitis compared with the control group (12.5%) (P =.02). CONCLUSIONS: Food hypersensitivity may be a factor, which should be considered in eczematous external otitis patients. Patients suffering from eczematous external otitis symptoms should be evaluated for food hypersensitivity.

Congenital vomeral bone defect in two thalassemia trait cases.

The nasal septum is composed of a perpendicular plate of ethmoid bone, quadrilateral septal cartilage, membraneous septum, crest of palatine and maxillary bone and vomer. Defects of the nasal septum may be due to a variety of causes such as trauma, infection, inhalant irritants and neoplasia. To our knowledge, up until now, congenital defect of the vomer has been presented in six cases without any nasal symptoms. We present two cases of congenital defect of vomer with thalassemia trait, the patients complaining of nasal obstruction.

[Toxoplasmosis in patients with lymphoid hyperplasia of the head and neck]. / Bas-boyun bölgesi lenfoid hiperplazisi olan olgularda toksoplazmosis.

OBJECTIVES: To investigate the incidence of toxoplasmosis in patients with lymphoid hyperplasia of the head and neck. PATIENTS AND METHODS: In this study, 53 patients (32 males, 21 females; mean age 11.2+/-4.3 years, range 5 to 22) were investigated. There were hypertrophic tonsillitis in 13 patients, hypertrophic tonsillitis and adenoid hyperplasia in 22 patients, adenoid hyperplasia in 10 patients, and lymphadenopathy of the neck in eight patients. In venous blood samples, IgM and IgG antibodies for Toxoplasma gondii were investigated with the enzyme-linked immunoabsorbent assay (Axsym, Abbott). RESULTS: Positive IgG was determined in 23 patients (48%) with hypertrophic tonsillitis (n=6), hypertrophic tonsillitis and adenoid hyperplasia (n=10), adenoid hyperplasia (n=3), and lymphadenopathy of the neck (n=4). Positive IgM was determined in 5 patients (9.4%) with hypertrophic tonsillitis (n=1), hypertrophic tonsillitis and adenoid hyperplasia (n=1), and lymphadenopathy of the neck (n=3). CONCLUSION: Toxoplasmosis, which is known to cause lymphadenopathy, may be a reason for lymphadenopathy of the neck. Toxoplasmosis should be considered in the differential diagnosis of untreated patients with tonsillitis, adenoid hyperplasia, and chronic neck lymphadenopathy.

Multiple huge osteomas of the mandible causing disfigurement related with Gardner's syndrome: case report.

As osteomas of the bones including the jaws may be the initial symptom or clinical finding in the Gardner's syndrome, this entity should always be included in the differential diagnosis. A 20-year-old boy was referred to our clinic from another medical center. Extra-oral examination of the patient revealed an obvious asymmetry and disfigurement of the left mandibular corpus, angle and ramus. A panoramic radiograph revealed two huge osteomas at the angle, ramus and two smaller osteomas at the inferior border of the mandible. At the same time, there were an impacted canine and premolar. Diffuse sclerosis of the whole mandible was also seen. Upon the suspicion of Gardner's syndrome, barium passage radiographs of the intestine were requested and multiple polyps were observed. All of these findings led us to the diagnosis of Gardner's syndrome. The oral and maxillofacial surgeon and the dentist needs to be aware of the components of this entity because manifestations in the head and neck including epidermoid cysts, osteomas, odontomas, exostoses, supernumerary and impacted teeth are common. At the same time, osteomas causing disfigurement on the face related with Gardner's syndrome with increased uptake in scintigraphic examination should be treated by surgical excision of the lesions.

[The correlation between computed tomography findings of the paranasal sinuses and the symptoms of acute sinusitis]. / Akut sinüzitte paranazal sinüs bilgisayarli tomografi bulgulari ile semptomlar arasindaki iliski.

OBJECTIVES: We investigated the relationship between symptoms, coronal paranasal computed tomography (CT) findings and anatomic variations in patients with acute sinusitis. PATIENTS AND METHODS: The study included 44 patients (23 females, 21 males; mean age 35 years; range 21 to 74 years) whose diagnosis was acute sinusitis by history and physical examination. A comprehensive inquiry into the symptoms was made and coronal paranasal CT scans were obtained in all the patients. Correlations were sought between symptom scores, CT scores, and anatomic variations. RESULTS: No correlations were found between anatomic variations and CT scores. Total symptom scores did not correlate with CT scores. A statistically significant correlation existed only between headache and CT scores. The most commonly affected sinuses were maxillary sinuses (73%), followed by posterior ethmoidal sinuses (60%). CONCLUSION: Our data suggest that routine CT evaluations are superfluous in acute sinusitis.

[The adverse effect of gas formation on prognosis in a patient with deep neck infection]. / Derin boyun enfeksiyonlu bir olguda gaz olusumunun prognoza olumsuz etkisi.

A seventy-one-year-old woman was hospitalized with a suspicion of deep neck infection and poor general health. She had been receiving treatment for hepatitis, diabetes mellitus, and cardiac failure and had a history of tooth ache and severe neck pain lasting for the past 10 days. She had been admitted to another center where she had received antibiotic treatment for five days for widespread swelling in the neck and lower extremities, fatigue, and difficulty in breathing and swallowing. Upon admission, computed tomography showed gas formation in the neck and facial regions. Prompt abscess drainage was performed and intense treatment with antibiotics was continued. Despite all efforts, the patient died on the second day of hospitalization from cardiopulmonary arrest. This case emphasizes how urgent drainage is when gas formation is detected in deep neck infections, with inevitable poor prognosis with antibiotic treatment alone.